Monthly Archives: July 2015

Healthcare is about making decisions. Do I need to see a doctor? What’s ailing my patient? What are the appropriate tests and procedures necessary to find out? What’s the right treatment plan? Having the right information readily available is essential for everyone to be able to make the best decisions.

But, too many times, it doesn’t happen. For the right information to be available when and where it is needed requires people and systems to talk to one another. For too many years, our information systems have not consistently met this goal. Sharing and using information across multiple technologies is referred to as interoperability, and for too long we have failed to achieve it to the desired degree.

In healthcare, we all want two-way, plug-and-play interoperability — the ability for the technologies we use to seamlessly exchange information. We want it to be easier; we want it to be less expensive; and we know it will be safer for our patients and the people who care for them.

When it comes to getting technologies to share data, healthcare organizations grapple with layers of complexity and redundancy. The current tools don’t enjoy the simple data portability like that of email or a USB drive. Picture a patient in a hospital bed surrounded by monitors, an infusion pump, a ventilator and a pulse oximeter. This equipment is typically purchased from different manufacturers and each comes with its own proprietary interface technology. This means hospitals have to spend scarce time and money setting up each technology in a different way instead of the devices being equipped with a consistent means for connectivity.

Furthermore, hospitals are usually forced to invest in a separate “middleware” system to pull together all these disparate pieces of technology to feed data from bedside devices to EHRs, data warehouses and other applications that aid in clinical decision-making, research and analytics. Many, especially older, devices don’t even connect; they require manual reading and data entry. This lack of plug-and-play interoperability can compromise patient safety, impact care quality and outcomes, contribute to clinician fatigue and waste billions of dollars a year.

As healthcare professionals, and as an industry, we can no longer accept the status quo. It is possible to have real-time, two-way, low-cost, standards-based connectivity that enables improved decision-making and assures safety at lower cost. The technical capability exists. However, a byproduct of our fragmented national healthcare system is that vendors lack incentives to make their technologies work in a plug-and-play manner.

Some efforts are underway to address aspects of the interoperability challenge, particularly data exchange among EHRs. However, solutions need to be nationwide in scale and take into account the full range of data sources. Integrating medical devices, a source of objective biometric and clinical data, in a plug-and-play way needs to be a national priority. The entities buying, deploying and using these technologies — hospitals and health systems — must unite to solve their shared technical challenges and work with vendors to compel change.

We have an ethical obligation to develop and implement plug-and-play clinical devices and information technology systems. Potential improvements from doing so include avoiding or reducing adverse events, transcription errors and redundant testing. Clinicians will benefit from reduced alarm fatigue and time spent manually entering information. Our patients will benefit from decreased length of hospital stays through our ability to improve the speed of information transfers and lower costs related to integrating and maintaining technologies.

We must make it easier for healthcare professionals to perform the work they’re passionate about — taking care of people. We must make sure data gets to our researchers so they can discover the next wave of cures and clinicians can continue to refine best practices. Above all, we must do our utmost for our patients.

About the authors

Dr. Michael Johns is founding chairman of the Center for Medical Interoperability. His distinguished career includes leadership roles at the University of Michigan Health System, Emory University, Johns Hopkins and the Institute of Medicine.

Dr. William Stead is chairman of the Technical Advisory Committee of the Center for Medical Interoperability. He is Associate Vice Chancellor for Health Affairs and Chief Strategy Officer at Vanderbilt University Medical Center. He is renown in the field of biomedical informatics.

The current lack of interoperability between medical devices and other healthcare IT tools represents both a safety dilemma and an ethical issue, according to leaders with the Center for Medical Interoperability.

Michael Johns, M.D., founding chairman of the center, and William Stead, M.D., chairman of the center’s technical advisory committee–in a post to Becker’s Health IT & CIO Review–call data sharing efforts of healthcare organizations “complex” and “redundant,” noting that most tools have their own separate interfaces. To that end, they say, hospitals are forced to invest precious resources in additional systems to ensure all devices and systems talk to one another.

“This lack of plug-and-play interoperability can compromise patient safety, impact care quality and outcomes, contribute to clinician fatigue and waste billions of dollars each year,” Johns and Stead write. With that in mind, they say the industry has “an ethical obligation” to push for improved tools.

“Our patients will benefit from decreased length of hospital stays through our ability to improve the speed of information transfers and lower costs related to integrating and maintaining technologies,” they add.

“If the big systems start saying, ‘We’ll only buy stuff if it interoperates,’ then you will start to see change happen more rapidly,” Smith said.

The Office of the National Coordinator for Health IT, in January, released a shared nationwide roadmap for interoperability. Along with the roadmap, ONC also released a draft of 2015 Interoperability Standards Advisory, which “represents ONC’s assessment of the best available standards and implementation specifications for clinical health information interoperability as of December 2014.” An updated version of the roadmap is expected to be published sometime this year.

For interoperability between medical devices to become a reality, providers have to be the ones to ask that integration be a requirement, according to Joseph Smith, M.D., chief medical and science officer at the West Health Institute.

San Diego-based West Health is leading a push for a common language for medical devices; and through a grant from the Gary and Mary West Foundation it created the Center for Medical Interoperability in 2013.

“We’ve asked the FDA to issue draft guidelines on what interoperability should look like,” Smith tells the San Diego Union-Tribune in an interview. “They’ve said they would, and at this point, they’re about six months late.”

Vendors are seeing the benefits of interoperability and are beginning to integrate their own product lines, he adds. At the same time, many don’t talk to each other because it won’t benefit their business; currently, by not having devices that talk to others, vendors retain their competitive advantage.

To that end, Smith says, it’s up to the providers to push for change.

“If the big systems start saying, ‘We’ll only buy stuff if it interoperates,’ then you will start to see change happen more rapidly,” he says.

Some in the industry, including execs at West Health, have been calling for device interoperability to be a priority in the industry for years.

The Office of the National Coordinator for Health IT, earlier this year, released a shared nationwide roadmap for interoperability. Along with the roadmap, ONC also released a draft of 2015 Interoperability Standards Advisory, which “represents ONC’s assessment of the best available standards and implementation specifications for clinical health information interoperability as of December 2014.”

West Health director explains why you should care about interoperability

TORREY PINES — Text messages, photos, even videos flow between billions of people every day, and it usually makes no difference who manufactured the smartphone that is sending and receiving the data.

Not so for medical devices. While technology in the consumer world grows more connected every day, that has not been the case with the high-tech tools used to care for patients.

“You would think that health care would be a first-order need, but we’re kind of the last in the queue to have seamless sharing of information. In some instances, we’re still using fax machines,” said Dr. Joseph Smith, chief medical and science officer at the West Health Institute.

The nonprofit medical research organization in Torrey Pines is leading a nationwide push to create and implement a common language for medical devices. This ability to “interoperate” would not only be safer for patients, but also potentially save $30 billion, according to the institute.

With a $10 million grant from the Gary and Mary West Foundation, the group established the Center for Medical Interoperability.

It formed a board of directors that includes some of the largest names in health care, including Vanderbilt University, the Cedars-Sinai Health System, Ascension Health and Hospital Corporation of America. Locally, Scripps Health CEO Chris Van Gorder is a board member, along with Smith and West Health Institute CEO Nick Valeriani.

Dr. Joseph Smith

Age: 58Family: Wife, Ann; two sons, ages 17 and 18Position: Chief medical and science officer, West Health Institute; board member for Center for Medical InteroperabilityCareer: Former vice president of emerging technologies for Johnson & Johnson, chief medical officer of Guidant/Boston Scientific’s cardiac rhythm management program, two decades of practicing cardiology at Brigham and Women’s Hospital in Boston, Washington University in St. Louis and the Arrhythmia Institute in VirginiaEducation: Medical doctorate from Harvard Medical School; Ph.D. in medical engineering and physics from Harvard-MIT Division of Health Sciences and Technology

Smith recently explained the interoperability concept during an interview with The San Diego Union-Tribune. The following is an edited transcript:

Q: What does this interoperability problem look like at the bedside in a hospital?

A: Imagine you’re in an intensive-care unit where you’re surrounded by half a dozen, maybe even a dozen, smart medical devices. You’ll have a couple infusion pumps that are busy giving you medicine. You’ll have a blood-pressure monitor. You might have an oximeter to measure the amount of oxygen in your blood. You have a bed that’s capable of inflating and deflating to try to keep you from getting blood clots. You may be intubated. You may have continuous glucose monitoring if you’re diabetic.

Each of those devices is optimized to work as if it’s alone.

We ask health care providers — nurses, doctors, technicians — to look at all of those individual instruments, integrate their information and make a decision.

For example: Let’s say one of those infusion pumps is delivering blood-pressure medicine, but your heart monitor shows that the dose you’re receiving is not enough to control your blood pressure. Wouldn’t you want that pump to be able to adjust the dose within pre-established safe parameters? Of course you would, but we haven’t. We ask the nurses to do that. We force that delay and introduce the potential for mistakes by having a person in the middle.

Q: Do you think a fear of technology and a desire to have people ultimately in direct control of medical decisions, like real-time medication adjustment, has held back interoperability?

A: I’m not sure about that. We have many other situations in our daily lives where computers very swiftly make decisions, based on data they collect, to save lives. I’ve spent half of my life designing and implanting cardiac defibrillators that make a decision to deliver a shock within seconds or it’s too late. They save lives every day and they do so autonomously. Pacemakers do the same thing every day.

We’ve gotten comfortable with automatic measurement and automatic control, when there are no other options, and it’s been wildly successful.

Q: What is the biggest force holding back greater interoperability in the wider health care world?

A: We’ve been successful, like the airline industry, in areas where everything is controlled by one vendor. Boeing controls every system in the aircraft it manufactures in the same way that everything inside a pacemaker is controlled by the company that made it. But once you get inside a hospital, you’re dealing with many vendors. We have not yet found a way to make those different vendors all speak the same language, so that they can communicate.

One of the big issues is that vendors are held responsible for the performance of their devices by the U.S. Food and Drug Administration. There is a big open question about how you make sure that the information you’re taking in from other sources, which you did not design and do not control, is accurate and reliable.

Q: What is the Center for Medical Interoperability doing to bring about better communication across vendors?

A: We’ve asked the FDA to issue draft guidelines on what interoperability should look like. They’ve said they would, and at this point, they’re about six months late. There are vendors who see that interoperability is the way things have to go, and they are starting to integrate their own product lines.

But trying to communicate with someone else’s product line is still challenging. Also, vendors in some ways do not have a business interest in talking to each other. If a manufacturer has a dominant share in the market, they have to use my proprietary network, and that can provide a competitive advantage.

Q: What, then, will get vendors talking to each other?

A: In order to make real progress, the purchasing community has to ask for integration. It has to become a user requirement. That’s why we’re working with large health systems very closely.

We’ve been working in the C suites of hospital systems to educate executives that there is money to be saved, switching costs to be avoided and that patient safety can be increased. If the big systems start saying, “We’ll only buy stuff if it interoperates,” then you will start to see change happen more rapidly.

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About the Center

The Center for Medical Interoperability is a 501(c)(3) cooperative research and development lab founded by health systems to simplify and advance data sharing among medical technologies and systems. We provide a centralized, vendor-neutral approach to performing technical work that enables person-centered care, testing and certifying devices and systems, and promoting the adoption of scalable solutions.

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